Inspection on 12/07/07 for Bankfield Premier Care

This inspection was carried out on 12th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bankfield Premier Care 13/01/09

Bankfield Premier Care 12/05/08

Bankfield Premier Care 04/12/07

Bankfield Premier Care 23/06/06

Bankfield Premier Care 01/11/05

Bankfield Premier Care 07/06/05

Bankfield Premier Care 14/09/04

Bankfield Premier Care 20/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bankfield Premier Care Gigg Lane Bury Lancs BL9 9HQ Lead Inspector Julie Bodell Unannounced Inspection 12th July 2007 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bankfield Premier Care Address Gigg Lane Bury Lancs BL9 9HQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 764 8552 0161 761 3689 donnabrowne@bankfield.org www.bankfield.org Mr David Arthur Hopkins Denise Rimmer Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 47 service users to include:*Up to 47 service users in the category of OP (old age not falling within any other category). 23rd June 2006 Date of last inspection Brief Description of the Service: Bankfield Premier Care Home is a care home providing personal care for older people over 65 years of age. It is a large purpose-built detached home situated in a residential area of Bury, close to Bury football club. It is close to main bus routes and is approximately 3 miles away from Bury town centre. There is limited parking to the front of the home for the use of staff and visitors. There is a large enclosed courtyard at the back of the home. This has a well-stocked garden area and plenty of seating for the residents. The home is registered to care for 47 residents and provides accommodation on the ground and first floor. Most of the bedrooms are single rooms and 22 of the single rooms have an en-suite facility of toilet and wash hand basin. The bedrooms on the first floor are reached either by stairs or a passenger lift. There is one large dining room and several lounge areas. Several of the toilets and bathrooms have aids to assist any resident with a disability or mobility problem. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which the home did not know was going to take place. It lasted for one day. Three inspectors were involved in the inspection including a CSCI pharmacist inspector who examined the medication system. Two inspectors spent time talking to the registered manager, the newly appointed head of operations, residents, five members of the staff team and a visitor. They looked at paperwork and at parts of the home as well as watching what went on. On 24th May 2007 a meeting took place with the registered providers and we shared our concerns with them about the lack of action being taken to address longstanding requirements at the home. We made it clear to the registered providers that this situation could not continue. The registered providers accepted our findings and had already taken action to address the issues. A new middle management team has now been formed and there are plans in place to improve service delivery at the home. CSCI are, at this time, confident that the registered providers will make every effort to comply with CSCI findings. This inspection report reflects the beginning of this process. CSCI will visit the home again to check that improvements are being undertaken and that good practice is being maintained. As part of the inspection process the registered manager completed an annual quality assurance assessment, which was returned to CSCI. No feedback surveys were received from residents or relatives in respect of the home. What the service does well: Before residents move into the home the registered manager visits them in their own homes or in hospital to make sure that the care they needed could be provided by the home. Residents said it is “pleasant here” another said “don’t mind it here, the staff are nice and friendly.” A response in a visitor’s questionnairre for the home stated, “staff are always friendly and welcoming.” The conservatories have a very pleasant outlook onto the enclosed courtyard. The courtyard was filled with beautiful hanging baskets and was a pleasant and safe environment for the residents to sit or walk around in. There are enough staff members on duty to meet the needs of the residents. They make sure that the residents are clean, comfortable and well dressed. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care plans and risk assessments still need some improvement so that staff have clear information about the needs of residents and how they are to support them safely. Suitable training is also needed for those staff members who are responsible for completing the new documentation to ensure that they are competent to do so. Medication must be given as prescribed at all times, this includes having an adequate supply of all prescribed medications to make sure residents have continuous treatment. The records about medication including controlled drugs must be clear and accurate and up to date so that they can show that residents are receiving their medicines properly and that they are safe from harm The home needs to continue to make progress in ensuring that there are opportunities for residents to be involved in activities and record when this is offered or happens. All managers’ within the organisation need to ensure that they have received up-to-date training in local vulnerable adults procedures to ensure that if an allegation is made about abuse they are clear about what action is to be taken. Policies and procedures for both complaints and the protection of vulnerable adult procedures need to be reviewed and revised. There needs to be an ongoing programme of redecoration and refurbishment throughout the home. To ensure the health and safety of residents the hot water temperature to the baths must be checked regularly and action taken immediately to rectify problems, if they arise. Control of infection measures in the bathrooms need to be improved. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 7 All staff must undertake any necessary training relevant to their roles and responsibilities. This is necessary to ensure that residents are in safe hands and they are competent to carry out their role safely. The registered providers must ensure that there are clear lines of accountability within the home as with any external management and ensure that the home is run smoothly and in the best interest of residents. The new pack of policies and procedures must be reviewed to ensure that they give staff members’ correct guidance and are legally correct. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All prospective residents have an assessment undertaken prior to admission to the home as it gives an assurance to the residents, relatives and staff that a resident is only admitted if the home can meet their needs. EVIDENCE: Bankfield has had no permanent admissions to the home since the last inspection but has had a number of respite admissions. However during this inspection two separate sets of relatives came unannounced to the home and looked round. Arrangements to carry out an assessment in one case, were made. The registered manager said that the staff put a pack of toiletries and information in new resident’s bedrooms, at the time of their arrival, as a welcoming gesture and this was seen during a look around the building. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 10 Three resident care files showed that assessments had been undertaken prior to admission. Before any resident was admitted to the home the registered manager undertakes an assessment of their needs. Assessments undertaken by other professionals requesting a residents’ admission i.e. care manager or social worker were also in place unless the resident is self-funding. The new care plan system has a pre-admission document in the pack. The newly appointed head of care is currently reviewing and revising the policy and procedure for admissions to the organisations group of homes. Once completed it must be introduced at the home in a way that ensures that the staff team have a clear understanding of what is expected of them when a new resident is admitted to the home. Standard 6 does not apply, as the home does not provide intermediate care. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although care plans contained useful information they did not fully reflect the support needs of some of the residents. Care practices ensured that the residents were treated with respect and dignity. Medication is not handled well and residents are at risk from harm. EVIDENCE: The care records for three residents were examined who all had high levels of need. The care records seen were adequate and in the main reflected the needs observed by the inspectors and identified during discussion with the registered manager. But concerns were raised about the level of detail in some information and that links were not always made between changes in care practices and risk assessments. Relatives had not been involved in developing the care plans and risk assessments. The head of care has recently purchased a new Spandex system of care planning and risk assessments that should improve record keeping and raise recording to a good standard. The Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 12 system has recently been introduced to the home and the registered manager has completed two plans and had found it to be a positive experience particularly when involving the resident. Relatives to are to be included in the process. Staff training must be delivered to ensure that the staff team were competent to complete all records. Risk assessment tools are also contained within the documentation. Risk assessments for residents with a high level of need must be prioritised and reviewed covering areas of nutrition (MUST), diabetes, pressure care, moving and handling, medication, continence care and bed rails. These must be done in detail and provide more information about the risks involved and clear guidance to the staff team on how they are to care and support the resident to ensure their health and safety. There were a number of concerns at this inspection around risk e.g. where a resident had a very high moving and handling score, more information on how the resident is to be supported needs to be expanded. The resident is quite confused and tries to walk alone at night if he wakes, which is unsafe as the resident mobilises using a frame and is at risk of falls. For another resident who is an insulin-controlled diabetic, the plan dated 30.05.06 and 01.07 states staff will do blood sugars monthly, which was actually being checked by the district nurse. For the third resident inspectors were informed that the district nurse was visiting the resident but there was no record of this on the plan or on district nurse visits records. A chiropodist was visiting the home on the day of the inspection. As part of this inspection the pharmacist inspector looked at the way medication was handled and if residents were given their medicines safely. The records about medication were looked at together with the medication held on behalf of the people who live in the home. The medication policy was being updated and was not available on the day of inspection. The records regarding medicines administration were not always completed accurately there were numerous of example of medication being recorded as given but stock checks done on the day of inspection by the inspectors showed that the tablets had not been administered. The stock checks also showed that there were a number of occasions when medication was administered but had not been signed for. There were a number of medicines, which could not be accounted for because the records were incomplete in that there was no audit trail. The records failed to provide evidence that residents were being given their medicines properly. The administration of medicines was a serious concern. On the day of inspection breakfast time medication was still being administered after 11am, this could put residents at risk, as there was not a safe or appropriate time interval between doses for some medicines. Some residents were not given their medicines exactly as prescribed by the doctor. For example one resident had been given double the dose of her sedative medication in error for a Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 13 considerable number of days, another resident had not been given the correct number of doses of an antifungal medicine and a third resident had not been given her antibiotics as prescribed. It was also seen that medication had ‘run out’ for one resident. Staff did not date medicines, which have a limited life once opened, residents were potentially being given medicines and eye drops which were out of date. Failure to administer medicines exactly as prescribed by the doctor could put residents health at risk. The manager had not audited the medicines for two months and was unaware of the poor administration of medicines. The manager identified that the way medication was checked was not robust and that a new way of checking needed to be developed. Medication was stored in a large room which was locked, however the medicines in the room were not locked away which could put residents at risk if they gained access to the room. During the inspection the inspector looked at how controlled drugs were handled, it was found that the records regarding controlled drugs were inaccurate. The records indicated that four patches should be in stock and a stock check by staff during the inspection had confirmed this, however when the inspectors counted the patches there were five in stock. It is of serious concern that staff failed to ensure an accurate record of controlled drugs is kept. The staff were observed treating residents with kindness and respect. There was a relaxed and unhurried pace at the home Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home enables residents to exercise as much personal freedom and choice as possible, although more activities could be provided for their enjoyment. The dietary needs of the residents are well catered for. EVIDENCE: Residents were observed in the large conservatory and the large and small lounges. Several residents were wandering from room to room and spending time in each room, whilst others were relaxing, watching TV, reading and chatting and despite some level of confusion, reminiscing about family life and events. A hairdresser was visiting and several ladies and gentlemen had their hair done. One resident asked for help from staff with reading, the staff member put her arm around the resident to reassure them and good eye contact was made. Residents said it is “pleasant here” another said “don’t mind it here, the staff are nice and friendly.” On the returned quality assurance forms from visitors activities were an area that was identified as poor and this area also featured as an area of need of improvement at the last inspection. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 15 The home has recently employed an activities organiser for two days a week. Inspectors spoke briefly to the person who has been appointed to the role, who has many years experience of working with older people, including activities. The activities organiser has already started to research the area and has been in contact with the local library and Age Concern to start the process. It is intended initially to concentrate on providing 1:1 time for residents. This area will be looked at again at the next inspection. There were many visitors to the home throughout the day. On the returned visitors questionnaires in answer to the questions, “How do you rate the quality of care and friendliness of staff?” answers were either excellent or good with comments like, “staff are always friendly and welcoming” and “Mum has been very happy at Bankfield and is very well looked after. I feel relaxed and content every time I see my mum, knowing I am leaving her in your capable hands.” Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. An inspector spoke with one of the two cooks at the home. Both cooks have been employed at the home for many years. A kitchen assistant was also on duty. The kitchen was found to be clean and tidy. In line with good practice the Safer Food Better Business the kitchen staff were completing documentation. A number of residents are on soft diets. The use of moulds for pureed foods had recently been introduced and was seen to be of very realistic appearance. The menu had been recently reviewed and a seasonal menu has been adopted. The residents were asked earlier on in the day for their choice of menu. Staff members ensure that the residents have a light snack for their supper and milky drinks, in addition to tea and coffee which are always available. Residents commented that the “food is nice and we get plenty” another “the foods pretty good and we get plenty.” The cleaning products provided in the kitchen were marked as office cleaning products in some cases and may not be suitable for commercial kitchen cleaning. This needs to be checked out. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All members of the staff team including the registered manager and deputy manager must attend relevant training to ensure that they deal with investigations in the correct way so that they may protect service users. Policies and procedures for vulnerable adult protection are being reviewed and revised to reflect current legislation. EVIDENCE: The head of operations has developed a new complaints procedure and a copy was found displayed in each resident’s bedroom. It gave an assurance that complaints would be responded to within 28 days. No complaints have been made to the CSCI in relation to care since the last inspection and the registered manager said there have been no internal complaints either. There have been no allegations of abuse at the home since the last inspection. The Home has a copy of the local authority procedures. The head of care for the organisation is reviewing and revising the current vulnerable adults policy and procedure to ensure that it complies with legislation and makes links to the local authority procedures. The registered manager and the deputy manager must attend training for managers’ in line with the local authority procedures, to ensure that if an incident were to occur that an investigation is not compromised by lack of understanding. Members of the staff team who have not attended recent protection of vulnerable adults training must do so. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 17 Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Bankfield provides a comfortable and homely environment for the residents’ living there. Some work is needed to the home to maintain good standards. Control of infection arrangements and checking hot water temperatures were found to be poor, which puts the health and safety of residents at risk. EVIDENCE: An inspector looked around the building and looked at most of the bedrooms. The entrance hall area was being repainted. The residents have the use of any of two lounges, two conservatories and a large dining room. These rooms were pleasant and very homely. However, the general visual appearance of some areas of the home was tired and in need of some redecoration and refurbishment. The conservatories have a very pleasant outlook onto the Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 19 enclosed courtyard. The courtyard was filled with beautiful hanging baskets and was an extremely pleasant and safe environment for the residents to sit or walk around in, weather permitting. Some corridor carpets were ill fitting and could present a trip hazard for residents. A new fence has recently been erected around the building at the rear to improve security. A fire officer visited the home recently and noted a number of areas of non-compliance. The registered manager and the general manager have moved swiftly to address these matters with only one area outstanding. It was noted that the majority of the staff team attended fire safety training on 27th June 2007. A smoke detector needs to be fitted in the archive room. Toilets were within close proximity of communal spaces. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were all clearly marked. Bathrooms were overall found to be in a poor condition with only one being used on a regular basis. All would benefit from some level of redecoration to make bathing a pleasant experience. Although the baths had bath hoist fitted they were very low and quite narrow. Discussion with the registered manager confirmed that the type of bath prevented some residents using them and it was also difficult for staff to support residents easily because they were so low. There were no hand-washing facilities in place for staff in the bathrooms because there were no sinks. In line with good practice there were water thermometers in the bathroom being used but the water temperature to the bath was 48 degrees centigrade, which is too hot. The bedroom doors were fitted with locks and each bedroom had a lockable space. The bedrooms were in many cases nicely arranged, particularly those overlooking the courtyard and most were highly personalised by families, some with fresh flowers. Many had televisions and a number had private phones. Hand washing facilities are now in place in residents’ bedrooms to prevent cross infection where a resident is receiving personal care. Many of the ensuites were in need of decoration. The condition of beds was checked. There was a wide variation in the quality of some mattresses and some require changing. Some beds were fitted with plastic protective covers, which were badly creased which could lead to an uncomfortable nights sleep for residents and aggravate pressure areas. Bedding was fresh but in some cases was found to be torn, had holes in or needed mending. Duvet covers were not used. There are plans in place to replace some bedroom furniture. The home was surface clean but some areas would benefit from a spring clean as cobwebs were found throughout the home and paintwork such as skirting boards, windowsills, etc were dirty. The home was mainly odour free but there is an unpleasant smell in three bedrooms. The laundry was clean and looked organised and adequate equipment was in place and protective clothing was available. The home has installed a new laundry system that kills all known germs including MRSA. All staff must undertake control of infection training. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Sufficient staffing levels are provided. Some improvements are needed to staff recruitment files and shortfalls identified in the training skills audit need to be addressed to ensure that all the staff team have undertaken the mandatory training that they need, to ensure the safety and protection of the residents. EVIDENCE: The rota for the week was examined and showed that there are generally six care staff members on duty in the morning, six in the afternoon and four in the evening including the registered manager and the deputy. There are three carers on duty at night. Cooks, kitchen assistants, laundry assistants, domestics and business administration support care staff members. The inspector is aware that there has been a significant turnover in staff since the last inspection, particularly amongst senior carers and including a number of retirements and staff leaving due to ill health. The recruitment records for a recently employed carer were examined. An employment history was in place but there was no documentary evidence of the qualifications held by the person. The person was waiting for there CRB check to be returned but there was no evidence on the file to show that a Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 21 POVAfirst check had been undertaken. Recording around criminal record checks for the organisation is poor. It is unclear who has had a check and who has not and the original documentation is not available. The registered manager and the head of operations were advised that original documents must be held until the inspectors have seen them in future. The head of operations is currently asking staff members to bring in their copy of their CRB to be checked against the information already held. The head of operations has made some considerable headway in this area and the head of operations is satisfied the CRB checks seen are acceptable. Written confirmation of the position at Bankfield is needed. There have been a number of changes to the arrangements for countersignatures for the home. The registered manager holds the Registered Managers Award as well as the NVQ Level 2 and 3. The deputy manager and two of the three senior staff hold NVQ Level 2. Of the 14 daytime staff employed at the home only 3 have completed NVQ Level 2 training. Work needs to be undertaken to improve this percentage. A training skills audit has been undertaken and information put into a spreadsheet. The spreadsheet identifies major shortfalls in mandatory health and safety training. A good example of the impact of the shortfalls would be hoist training. Comparing the rota to the skills audit there were only three members of the staff team out of eleven care staff members on duty on the day of the inspection that had received hoist training and two of those were out of date. Likewise only three of the staff team on duty had received control of infection training. None of the full staff team has had health and safety training. The registered manager has produced a list identifying what training the staff team needs to complete. Identified shortfalls in mandatory training must be addressed as soon as possible. The organisation is a member of the local training partnership, which provides this type of training through Skills for Care arrangements are being put in place to utilise this training facility. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager now has time available to ensure the day-to-day management and monitoring of the quality of care provided promotes the health, safety and welfare of service users and staff. The manager has made progress in her continuous professional development and the registered providers have become more involved in the operation of the home to ensure that it is being run in the best interests of the residents. EVIDENCE: The registered manager has 30 years experience of providing care to older people within the private sector and the NHS. She has been with the company for 5 years and has been the manager at Bankfield for 2 years and holds the Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 23 Registered Manager’s Award. The registered manager competed the fit person process with CSCI in September 2006. It was recommended at the interview that the registered manager as part of her continuous professional development look at undertaking NVQ Level 4 in care, as well as looking at doing more work around the Regulations and National Minimum Standards, equality and diversity and quality assurance. Due to a shortage of senior care staff the registered manager has not had the time to make much headway in terms of further training, though has sought funding without success for NVQ Level 4 in Care and has sent out questionnaires to relatives to start the quality assurance review and has had some feedback Since the last inspection there has been changes to the middle management of the organisation, which now include a head of operations, general manager and business administrator, who are there to support and advise the registered manager. Although vital to the operation of the running of the home they need to be clear about their roles, responsibilities and accountability to ensure that they do not unwittingly compromise the registered providers, registered managers’ and their legal responsibilities in respect of their registration. The registered manager said that the head of operations had been very clear about the fact that she is there to support and advise the registered manager but not to manager the home. The registered manager said that she felt the situation at Bankfield had improved in recent weeks after a very stressful period. The head of operations was said to be approachable and that many of the issues that had been a cause of concern for sometime, such as staff training, care planning and issues around the environment had started to be addressed and prioritised and that she could now see “light at the end of the tunnel.” The registered manager is keen to ensure her continuous professional development following a period of being unable to access training. This is particularly important if the manager is to ensure that training undertaken by staff is to be adopted as good day-to-day practice. The registered manager has booked herself on a number of courses including health and safety and management courses through the local authority training partnership. It was noted that the office was to be made bigger and that improvements to security were also to be made. Some confidential information was not being held securely. We spent time talking to the registered manager and the head of operations about the process for Inspecting for Better Lives, including KLORA, quality ratings, annual reviews and AQAA and showed the registered manager how to access information from the CSCI website. The registered providers or the head of operations are now undertaking the monthly Regulation 26 monitoring visits and a copy of the report completed is being sent to CSCI. A quality review of the service has started and the registered manager has had feedback from many relatives. It has been agreed that the head of operations will review and revise the pre-printed pack of policies and procedures. It was noted that she has already started on key documents. The home has the Investors in People award, which is currently being re-assessed. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 24 Maintenance and servicing records were checked and were generally found to be in good order. Confirmation is needed as too the status of the homes electrical fittings and fitments and whether the five points of action required at the gas safety inspection have been carried out. Internal checks are carried out with regards to fire safety checks, including drills, emergency lighting, means of escape etc. Water temperatures are also checked. However there were concerns that only a number of thermostatic mixer valves had been serviced following the requirement at the last inspection and water to a bath was found to be running at 48 degrees centigrade and the water to some sinks was running very hot to the touch. The requirement therefore stands. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 2 Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 15 Requirement Timescale for action 31/08/07 2. OP7 15 3. OP8 13 Once reviewed and revised, the admissions policy and procedure must be introduced to the staff team in a way that develops understanding of the importance of good practice in this area and be implemented by them. A copy of the final policy and procedure must be sent to the CSCI. The new recording format for 30/09/07 care planning, risk assessment and daily records must be put in place as soon as possible. Care staff members must receive training on how to complete the documentation to ensure competence and that the format is used efficiently and effectively. The risk assessments for 31/08/07 residents with a high level of need must be reviewed covering areas of nutrition (MUST), diabetes, pressure care, moving and handling, medication, continence care and bed rails. These must be done in detail and provide more information about the risk involved and clear guidance to the staff team on how they are to care and support DS0000008398.V337468.R01.S.doc Version 5.2 Bankfield Premier Care Page 27 4. OP9 13(2) 5. OP9 13(2) 6. OP9 13(2) 7. 8. 9. OP9 OP9 OP9 13(2) 13(2) 24(1) 10. OP15 13 11. OP18 13 the resident to ensure their health and safety. (Previous timescales of 31/12/05 and 31/08/06 not complied with in part) All records regarding medication must be accurate and up to date to show that residents are given their medicines properly. (Not met 22.05.06). All medication must be administered to residents exactly as prescribed. This includes ensuring that all residents have sufficient supplies of medication to ensure continuity of treatment and that medication is given at appropriate times. (Not met 22.05.06). All medication must be accounted for at all times by means of a clear and auditable trail to ensure that medication is given in the correct doses. All medication is stored securely at all times to ensure residents’ health and safety is not at risk. Medication must not be out of date when it is administered. Timescale:12/07/07 A system must be established and maintained to ensure that the quality of medication handling is evaluated in order to make sure residents are safe when they are given their medicines. The cleaning products provided in the kitchen that are marked as office cleaning products in some cases must be checked to ensure that they are suitable for commercial kitchen cleaning. That all managers’ who might become involved in abuse investigations need to undertake the necessary training to ensure that they respond appropriately DS0000008398.V337468.R01.S.doc 12/07/07 12/07/07 12/07/07 12/07/07 12/07/07 12/08/07 31/07/07 30/09/07 Bankfield Premier Care Version 5.2 Page 28 12. OP19 23 13. OP19 13 14. OP19 23 15. OP21 23 16. OP21 13 17. OP24 13 16 to allegations. All members of the staff team must receive training in vulnerable adults procedures to ensure that protection of service users. The internal policy and procedure for the home needs to be reviewed and revised and ensure that it makes clear links to the local authority procedures. A smoke detector needs to be fitted in the archive room to ensure that the home is fully covered by the fire alarm system to ensure the health and safety of residents. That the identified corridor carpets are either repaired or replaced to prevent them becoming a trip hazard for residents. A rolling programme of decoration and refurbishment must be put in place for the home with clear timescales to improve the physical environment for residents. A copy of the plan must be sent to CSCI. A review of the present arrangements for bathing must be undertaken with some urgency and a plan of what improvements are to be made with timescales. Plans must include hand-washing facilities for staff. The thermostatic control valves must be serviced in accordance with requirements. Evidence of this must be forwarded to the CSCI by the date set. (Previous timescale of 31/01/06 and 31/08/06 not complied with) All mattresses and bedding must be checked to ensure that they are of good quality and were not they must be replaced. Checks DS0000008398.V337468.R01.S.doc 31/07/07 31/08/07 31/08/07 31/08/07 31/07/07 31/07/07 Bankfield Premier Care Version 5.2 Page 29 18. OP26 13 19. OP26 13 20. OP28 18 21. OP29 19 22. OP29 19 23. OP30 18 24. OP31 12 must include the plastic protective mattress covers to ensure that they are crease free to promote tissue viability and a good nights sleep. Parts of the home are in need of a thorough clean and were there is malodour then the source of the problem must be found. To ensure that cross contamination is prevented all staff must attend a control of infection course. The registered provider needs to increase the level of NVQ Level 2 training to cover all areas across the staff team. To ensure that the residents are supported and protected through the homes recruitment policy and practices record keeping must be improved. The registered providers must assure CSCI that all members of the staff team hold a satisfactory CRB check and write to CSCI to confirm that this has been done and that CRB checks are all satisfactory. To ensure that the service users are protected by the homes recruitment procedures a copy of the prospective employees qualifications must be taken. Where a CRB has been sent for a copy of the POVAfirst clearance must be on file. To ensure that the residents are in safe hands the shortfalls in mandatory health and safety training identified on the skills audit must be addressed as a matter of urgency. To ensure that the home is run smoothly and in the best interest of residents, the registered providers must ensure that there are clear lines of accountability DS0000008398.V337468.R01.S.doc 31/07/07 30/09/07 31/10/07 31/07/07 31/07/07 30/09/07 31/08/07 Bankfield Premier Care Version 5.2 Page 30 25. OP33 13 26. 27. OP37 OP38 17 13 within the home and with any external management. The pack of policies and procedures is reviewed in accordance with legislation and good practice to ensure the health, safety and protection of residents. To ensure residents rights to privacy and confidentiality records must be securely held. To ensure the health and safety of residents’. CSCI require written confirmation that any outstanding work on the NICEIC certificate and the gas safety certificate has been addressed. 30/09/07 31/07/07 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The home needs to continue to make improvements in the provision of activities for residents. Bankfield Premier Care DS0000008398.V337468.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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